Hormonal Contraceptives for Endometrial Cancer Prevention in Obese and High-Risk Women in Virginia.

Abstract

Endometrial cancer remains the fourth most common malignancy among US women, and hormonal contraceptives drastically reduce this risk. The study objectives were to assess the prescribing patterns, counseling practices, and knowledge of family physicians and obstetrician/gynecologists (OB/GYNs) regarding hormonal contraceptives, obesity, and cancer prevention. A 25-question survey was mailed to 4600 OB/GYNs and family practitioners licensed in Virginia to assess self-reported hormonal contraceptive prescription practices, patient evaluation and counseling, and gynecologic oncology knowledge. χ2 and t tests were used to assess for differences across groups. P < 0.05 was deemed significant. In total, 392 (9%) surveys were returned, with 256 (6%) being complete for analysis. The mean physician age was 53.6 years, 50.2% were men, and 92.6% of physicians prescribed hormonal contraception. Most physicians recognized decreased endometrial cancer risk associated with oral contraceptive pills (73.0%) and increased risk with obesity (95.3%), but only 36.7% consistently counseled patients on obesity-associated cancer risk. Compared with family physicians, OB/GYNs were more likely to cite endometrial cancer prevention as an indication for hormonal contraceptives (53.3% vs 10.9%, P < 0.0001); more often counseled patients on obesity-related cancer risk (P = 0.003); and were more likely to correctly identify Lynch syndrome (69.4% vs 22.5%, P < 0.0001), diabetes mellitus (85.2% vs 38.8%, P < 0.0001), and hypertension (41.7% vs 10.1%, P < 0.0001) as risk factors for endometrial cancer. Endometrial or ovarian cancer prevention factored into <2% of total hormonal contraception prescriptions; however, OB/GYN physicians were more likely to prescribe for those indications than family physicians (P = 0.005 and P < 0.001, respectively). Family physicians and OB/GYNs could improve their knowledge of endometrial cancer risk factors and the use of hormonal contraception for chemoprevention. This represents a significant opportunity for both specialties to optimize primary endometrial cancer prevention in their increasingly obese and at-risk female patients.